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Throat Biopsy: To Sleep or Not to Sleep?

You are hoarse for more than 6 weeks. You smoke once in a while. You astutely sense that persistent hoarseness for more than 6 weeks is not normal and you go see your doctor. Your doctor sends you to an ear, nose and throat (ENT) specialist because of your persistent hoarseness. During the examination (as previously seen on The Dr. Oz Show) the ENT doctor sees something on your vocal cord. What is it? It is a mass. Not necessarily a cancer, it could certainly be a benign process like a polyp or a cyst. But some lesion that is sitting on your vocal cord that is responsible for your hoarseness.

You are hoarse for more than 6 weeks. You smoke once in a while. You astutely sense that persistent hoarseness for more than 6 weeks is not normal and you go see your doctor. Your doctor sends you to an ear, nose and throat (ENT) specialist because of your persistent hoarseness. During the examination (as previously seen on The Dr. Oz Show) the ENT doctor sees something on your vocal cord. What is it? It is a mass. Not necessarily a cancer, it could certainly be a benign process like a polyp or a cyst. But some lesion that is sitting on your vocal cord that is responsible for your hoarseness.

The ENT doctor says you need a biopsy of the mass so one can determine exactly what it is. The question is: Do you have to go to the operating room to have a biopsy of this mass on your vocal cord? In other words, do you have to be put to sleep in order for your ENT doctor to obtain a small piece of tissue from this mass, or to even remove it completely?

Let’s talk a little bit about what it means when you are put to sleep in the operating room. To be put to sleep in the operating room typically means undergoing general anesthesia. During general anesthesia an intravenous line is placed in your vein and a breathing tube is placed into your lungs. You are lying flat on your back and the breathing tube breathes for you while you are completely asleep for the procedure. The up side of general anesthesia is that you are completely knocked out for the procedure, you don’t feel anything while the procedure is being performed and you wake up after the procedure is completed. The down side of general anesthesia is that you will lose a day of work as the medications that put you to sleep require a day or so to recover from. Also, general anesthesia has certain risks. Is there any other way to do a vocal cord or throat biopsy without using general anesthesia?

The answer is yes. Over the past several years techniques have been developed and perfected which allow throat and vocal cord biopsies to be performed without using general anesthesia. That is, biopsies can be carried out in the office of your ENT doctor with you sitting upright in a chair, wide awake. You won’t feel any pain, you will not gag and you will not even need to have an intravenous line placed inside you and no breathing tubes are necessary. Most importantly, doing the biopsy without using general anesthesia is much safer than going to sleep. Furthermore, you can get up and leave the ENT doctor’s office 5 minutes after the procedure is completed. How is this done?

Ultra thin instruments called endoscopes are as thin as a piece of spaghetti and contain a camera. By placing this skinny scope through the nose, the vocal cords can be reached without activating the gag reflex. The gag reflex sits in the mouth, so by going through the nose one is avoiding where the reflex is primarily located. Numbing medicine is sprayed into the nose before the scope is inserted so you don’t feel uncomfortable while the scope travels through the nose to reach the vocal cords. Once near the vocal cords, a small amount of anesthetic spray is then given right on the vocal cords. Two minutes later the area of the throat or vocal cord that is to be biopsied is numb and a biopsy can then safely take place.

As soon as the biopsy is over, the scope is removed from the nose and you can then return to work or to play. For more information please go to www.voiceandswallowing.com

Blog written by Jonathan E. Aviv, MD, FACS
Author of over 60 scientific papers in peer-reviewed journals and Flexible Endoscopic Evaluation of Swallowing with Sensory...